Social Worker MSW - Care Management - HPW - FT - Day

Capital Health (US)•Hopewell, NJ

1d•Onsite

About The Position

This position assesses, diagnoses, intervenes with, and plans for social work services related to patient and family bio-psycho-social needs and behaviors. The role integrates assessment using information related to cultural, clinical, ethnic, age, and other factors into the plan of care to implement transition plans and treatments. The Social Worker acts as an active team member in the discharge planning process, primarily responsible for identifying complicated social and financial factors and barriers to appropriate discharge. The position ensures patients are referred to available, appropriate social and financial resources post-discharge to facilitate efficient patient transition and achieve desired outcomes. Additionally, the Social Worker refers patients/families and caregivers to appropriate resources regarding abuse/neglect/domestic violence, alcohol, and substance abuse. The role also performs clinical interventions related to grief counseling, bereavement, adjustment, and crisis intervention to support transition planning and enhance patient/family coping skills.

Requirements

Master's degree in Social Work (MSW)
Social Worker - Licensed
Excellent communication, conflict management, organizational and planning skills
Clinical training in a medical/clinical environment
Knowledge of spreadsheet and word processing software, case management and patient information systems

Nice To Haves

One year experience in a clinical setting performing clinical social work

Responsibilities

Documents clinical record, comprehensive assessment of patient needs including barriers to timely discharge, clinical interventions, support and appropriate community resources according to policy and utilizing recognized format, such as, assessment, intervention, and plan.
Documents clinical record appropriate interventions including assessment, plans, and referrals in the discharge planning process.
Uses culturally competent skills to assess individual patient needs and refers to appropriate professional staff when necessary.
Identifies barriers and plans for intervention to overcome or lessen barriers to achieve outcome as evidenced by treatment plan.
Collaborates, educates and assists health care team to identify social and financial barriers that delay appropriate transitions through multidisciplinary rounds, length of stay meetings, and medical record documentation.
Documents in clinical record all referrals and clinical interventions related to abuse, neglect, domestic violence, alcohol and substance abuse, crisis intervention.
Performs educational sessions for health care team related to abuse/neglect issues and reporting of same.
Documents staff interventions in clinical record.
Counsels staff and patient/family on conflict management in health care setting and monitors reaction and need for ongoing intervention.
Completes mental health /psych assessments when appropriate.
Advocates for appropriate services for all patients with payor and providers of post-acute care service, community service and other services in order to optimize patient outcome.
Participates in staff development and performance improvement program activities to increase self knowledge, staff and colleague awareness of bio-psycho-social issues and functioning, improve departmental and systems design and functioning, and meet regulatory requirements.
Attends and participates in regular departmental performance programs, staff meetings, and hospital wide committees to analyze and respond to issues significant to social work services and to identify opportunities for improvement.
Assists in data collection and information gathering on patient care issues, program and systems analysis in order to comply with plan, do, check, act performance improvement standards of JCAHO.
If applicable, may participate and develop inpatient and community programs that benefit patient, families and staff.
Implements support groups for specified disease processes or bio-psycho-social issues to assist community outreach and development.
May perform follow up service as needed to measure clinical outcomes.
Performs other duties as assigned.